PROVIDENCE FACEY MEDICAL FOUNDATION
NPI 1194083824
Clinic/Center - Ambulatory Surgical in Mission Hills, CA

NPI Status: Active since May 01, 2012

Contact Information

11333 SEPULVEDA BLVD
SUITE 3200
MISSION HILLS, CA
ZIP 91345
Phone: (818) 837-5776
Fax: (818) 837-5810

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  • Organization
  • Clinic/Center
  • Ambulatory Surgical
  • CLIA Number: 05D2044481
  • CLIA Cert. Type: Other - OUTPATIENT ENDOSCOPY CTR
  • CLIA Exp. Date: 07-24-2026

About PROVIDENCE FACEY MEDICAL FOUNDATION

This page provides the complete NPI Profile along with additional information for Providence Facey Medical Foundation, a provider established in Mission Hills, California operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1194083824 assigned on May 2012. The practitioner's primary taxonomy code is 261QA1903X. The provider is registered as an organization and their NPI record was last updated one year ago. The provider's . The authorized official of this NPI record is Donald Wayne Anderson Jr. (Assistant Secretary Of Enrollments)

NPI
1194083824
Provider Legal Name
PROVIDENCE FACEY MEDICAL FOUNDATION
Other Organization Name
Other Name Type
(6)
Entity Type
Organization
Location Address
11333 SEPULVEDA BLVD SUITE 3200 MISSION HILLS, CA 91345
Location Phone
(818) 837-5776
Location Fax
(818) 837-5810
Mailing Address
FILE 50670 LOS ANGELES, CA 90074
Is Sole Proprietor?
No
Is Organization Subpart?
Yes
Enumeration Date
05-01-2012
Last Update Date
05-06-2025
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Clinic/Center Ambulatory Surgical

Taxonomy Code
261QA1903X
Type
Ambulatory Health Care Facilities

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

DONALD WAYNE ANDERSON JR.

Authorized Official Title
ASSISTANT SECRETARY OF ENROLLMENTS
Authorized Official Phone
(425) 358-9786

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope

This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.

This service was performed 106 times for 106 patients

Biopsy of large bowel using a flexible endoscope

A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.

This service was performed 137 times for 137 patients

Colorectal cancer screening; colonoscopy on individual at high risk

Colorectal cancer screening, specifically a colonoscopy, is a preventive measure for those at high risk. A thin, flexible tube with a camera inspects the colon to spot any abnormal growths. This test helps detect potential issues early, enhancing the effectiveness of treatment.

This service was performed 26 times for 26 patients

Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk

Colorectal cancer screening, such as a colonoscopy, is a preventive measure to detect early signs of cancer in the large intestine. For individuals not at high risk, it's typically recommended at age 50. A small, flexible tube with a camera is used to examine your colon. It's a safe, effective way to catch issues early.

This service was performed 28 times for 28 patients

Diagnostic exam of large bowel using a flexible endoscope

This procedure, known as a colonoscopy, involves using a flexible tube with a light and camera to examine the large intestine. It helps detect any abnormalities such as polyps or inflammation. It's a standard procedure to ensure gut health.

This service was performed 18 times for 18 patients

Removal of polyps or growths of large bowel using an endoscope with mechanical snare

This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.

This service was performed 100 times for 98 patients

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
05D2044481
Facility Type
Other - OUTPATIENT ENDOSCOPY CTR
Certificate Effective Date
July 25, 2024
Certificate Expiration Date
July 24, 2026
Laboratory Director
ERIC DAVYDOV
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Providence Facey Medical Foundation to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1194083824, we treat the final digit (4) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 66. The final step is to find the difference between that total and the next multiple of ten (70 - 66 = 4).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
1
Unchanged
Pos 3
9
Doubled → 18 → 1 + 8
Pos 4
4
Unchanged
Pos 5
0
Doubled → 0
Pos 6
8
Unchanged
Pos 7
3
Doubled → 6
Pos 8
8
Unchanged
Pos 9
2
Doubled → 4
Check
4
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 9 → 18 → 9 0 → 0 3 → 6 2 → 4

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 1 + 1 + 8 + 4 + 0 + 8 + 6 + 8 + 4 + 24 = 66

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 66 is 70. The difference is the calculated check digit.

70 - 66 = 4
This NPI is valid
The calculated check digit is 4, which matches the last digit of 1194083824.

Other Providers at the Same Location


The following 20 providers are registered at the same or a nearby location.

Family Medicine
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Internal Medicine
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Internal Medicine
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Internal Medicine
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Internal Medicine
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Nurse Practitioner (Family)
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Pharmacy (Community/Retail Pharmacy)
11333 SEPULVEDA BLVD, SUITE 1200
MISSION HILLS, CA 91345
Dermatology
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Physical Therapist
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Internal Medicine (Hematology & Oncology)
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Obstetrics & Gynecology
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Nurse Practitioner (Obstetrics & Gynecology)
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Internal Medicine (Gastroenterology)
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Internal Medicine (Endocrinology, Diabetes & Metabolism)
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Internal Medicine
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Obstetrics & Gynecology
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Internal Medicine (Hematology & Oncology)
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Physical Therapist
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Physical Therapist
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345
Internal Medicine (Nephrology)
11333 SEPULVEDA BLVD
MISSION HILLS, CA 91345

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1194083824, enumerated as an "organization" on May 01, 2012.

The provider is located at 11333 SEPULVEDA BLVD SUITE 3200 MISSION HILLS, CA 91345 and the phone number is (818) 837-5776.

Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.